The British Association of Sexual Health and HIV (BASHH) has today launched new NICE accredited treatment guidelines to help prevent a little known but common sexually transmitted infection (STI) called Mycoplasma genitalium (MG), from becoming a ‘superbug’ within ten years.i However new BASHH research, also released today , reveals that seven in ten sexual health experts around the country said they couldn’t afford diagnostic tests recommended by the guidelinesii, and only one in ten UK public health commissioners said they were making provisions for testing equipment in their 2019 budget.iii BASHH is extremely concerned that the guidance will not be implemented in time to prevent the infection, which currently affects 1 in 100 people, from becoming an untreatable. Worryingly, if this happens, up to 3000 women a year who have pelvic inflammatory disease (PID) caused by MG could be at increased risk of infertility.iv
Today’s new guidelines have been issued just a few months after the first ever case of “super-Gonorrhoea” was reported in the UK. Although awareness of MG is low, it is in fact more prevalent than Gonorrhoea (N. gonorrhoeae).v It has similar symptoms to Chlamydia but is more resistant to treatment and if left untreated, can lead to PID in women, an infection of the reproductive organs that can cause infertility. 72% of sexual health experts said that if current practices do not change, MG infections will become a superbug, resistant to 1st and 2nd line antibiotics, within a decade.ii
BASHH spokesperson Paddy Horner, who developed the guidelines said “MG is treated with antibiotics, but as until recently there has been no commercially available test, it has often been misdiagnosed as Chlamydia and treated as such. This is not curing the infection and is causing antimicrobial resistance in MG patients. If practices do not change and the tests are not used, MG has the potential to become a superbug within a decade, resistant to standard antibiotics. The greatest consequence of this is for the women who present with PID caused by MG, which would be very hard to treat, putting them at increased risk of infertility.”
He continued: “These new guidelines have been developed, because we can’t afford to continue with the approach we have followed for the past 15 years as this will undoubtedly lead to a public health emergency with the emergence of MG as a superbug. Our guidelines recommend that patients with symptoms are correctly diagnosed using an accurate MG test, treated correctly then followed up to make sure they are cured. Resources are urgently needed to ensure that diagnostic and antimicrobial resistance (AMR) testing is available for women with the condition who are at high risk of infertility. We are asking the government directly to make this funding available to prevent a public health emergency waiting to happen and which is already spiralling out of control”.
The guidelines, which recognise the NICE approved principles of antibiotic stewardship published in 2015 , centre around the importance of targeted testing. According to 169 UK sexual health experts, such guidelines could deliver:ii
- Improved control of antibiotic resistance (78.88% agree)
- Precise diagnosis leading to optimal treatment (89.44% agree)
- Reduced costs associated with better treatment and faster resolution of MG cases with fewer follow-up cases (73.91% agree)
Further findings from the survey of 125 public health commissioners around the county revealed that:iii
- Only 1 in 10 of public health commissioners are planning to make a provision for funding of MG diagnostic nucleic acid amplification tests (NAATs) within their 2019/20 budget
- Two thirds of public health commissioners have not discussed the need to implement measures to better manage or address MG with either their sexual health provider and / or sexual health implementation group or equivalent body
- Only 17% say that support of diagnostic testing for MG has been implemented in their area
In addition, the survey of 169 sexual health experts revealed:ii
- 64% of BASHH members said their most recent local sexual health budget has decreased
- 70% said that constraints on funding of their service have restricted their clinic's ability to purchase new resources, central to delivering improved patient care
- 64% believe there is a lack of awareness of the importance of MG testing
- 83% do not routinely test for MG in symptomatic patients. 60% cite lack of funding or resources
- 85% feel national guidance around MG testing criteria is currently missing
BASHH president, Dr Olwen Williams said: “It is deeply worrying that only one in 10 service commissioners have made provisions for MG given the very severe consequences of inappropriate management, particularly on young women of a child-bearing age. We call on the government urgently to make this funding available and on sexual health experts to ensure they implement these new guidelines. By not addressing this issue despite warnings from experts, we are letting down young people in this country.”
Dr Peter Greenhouse, sexual health consultant from Bristol warned: “MG is rapidly becoming the new ‘superbug’: it’s already increasingly resistant to most of the antibiotics we use to treat Chlamydia and changes its pattern of resistance during treatment so it’s like trying to hit a moving target. The new guidelines will be helpful, but unless and until we get funds, so we can regularly test for it, we’ll be in the dark about which women with pelvic inflammatory disease have got it, and about what their true risk of long term complications are. Give us the tools and we’ll get on with the job.”
In 2017/18 local councils spent £30m less on sexual health compared to 2016/17, representing a five per cent reduction in the total amount of money available for services.vii Over the past four years, planned spending on sexual health services has fallen by £64 million (equivalent to 10 per cent).
References
i2018 BASHH UK national guideline for the management of infection with Mycoplasma genitalium. July 2017. Available online at: https://www.bashhguidelines.org/media/1182/bashh-mgen-guideline-2018_draft-for-consultation.pdfiiData on file. Survey of BASHH members, conducted via survey monkey in May 2018. Result based on 169 respondents during this time period.iiiData on file. Freedom of Information (FOI) request conducted in May 2018. Number of respondents 125ivData on filevSonnenberg, P., et al., Epidemiology of Mycoplasma genitalium in British men and women aged 16-44 years: evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Int J Epidemiol, 2015. 44(6): p. 1982-94viNICE. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. NG15 2015 available at: https://www.nice.org.uk/guidance/ng15viiThe King’s Fund. Big cuts planned to public health budgets. July 2017. Available online at: https://www.kingsfund.org.uk/press/press-releases/big-cuts-planned-public-health-budgets